Hyakuji Yabuuchi

Human Herpesvirus 6 Infection In Renal Transplantation

The relationship between renal transplantation and human herpesvirus 6 (HHV-6) infection was studied. All 21 kidney donors examined had antibody to HHV-6 at the time of transplantation. The 21 kidney recipients also had detectable antibody to HHV-6 before transplantation--and, of these, 8 patients showed a significant increase of serum antibody titer against HHV-6 after transplantation. All these 8 recipients suffered severe kidney rejection. Furthermore, virus isolation from peripheral blood lymphocytes of 2 recipients who suffered rejection was attempted, and in both cases HHV-6 was isolated. Biopsy specimens of rejected kidneys of 9 other patients were examined for the presence of HHV-6 antigens, and in 5 of these specimens antigens were detected in the tubular epithelium, as well as in infiltrating histiocytes and lymphocytes. These results suggest that HHV-6 can infect renal tissues and that the infection may be correlated with rejection or with immunosuppressive therapy.

Increased incidence of herpes zoster in normal children infected with varicella zoster virus during infancy: Community-based follow-up study

We surveyed outbreaks of varicella zoster virus (VZV) and herpes zoster virus, involving 31 outbreaks of chicken pox, in a semiclosed institution in Osaka Japan during the 34 years between 1949 and 1984. Eight hundred forty-nine infants and children who had had clinical varicella during the first 4 years of life and those who had resided in the institution at least 12 to 144 months after the onset of varicella were included in the study. Nine cases of zoster were observed among children who had acquired varicella during the first year of life, but there was no case of zoster in those who had acquired varicella after 1 year of age. In 61,800 person-months of observation, the overall incidence rate of zoster was calculated as 0.15 per 1000 person-months for the population at risk. The incidence rate in children infected with VZV when younger than 2 months was 1.0 per 1000 person-months during the first decade of life. This rate was significantly (P less than 0.005) greater than that (0.19 per 1000 person-months) in children who had varicella when they were 2 to 11 months of age. These observations suggest that zoster occurs at a significantly shorter interval if VZV infection is acquired during infancy. More than 85% of subjects with prior infection were intimately reexposed to epidemic varicella during their residency in the institution, before having zoster. Epidemic reexposure to varicella during follow-up resulted in enhancement of preexisting immunologic reactivity, but did not prevent subsequent zoster in the population studied.

Biochemical characterization of 1,25(OH)2D3 receptors in chick embryonal duodenal cytosol

SummaryThis study presents measurements of serum vitamin D metabolites, calcium and phosphorus as well as measurements of the equilibrium dissociation constant for duodenal 1,25(OH)2D3 receptor in 15-, 18-, 19-, and 20-day chick embryos in comparison to that in 1- and 118-day-old chicks and to vitamin D-deficient chicks. The present results showed that: (a) serum 1,25(OH)2D and 24,25(OH)2D levels rise from 15 and 18 to days 19 and 20 of embryonic development while serum phosphate levels are stable; (b) serum calcium levels rise at hatching to adult levels; (c) the duodenal 1,25(OH)2D3 receptor is detectable in 15-day-old embryo and has a Kd similar to that of 118-day-old vitamin D-replete chicks; and (d) the activity of 1,25(OH)2D3 receptor in chick duodenal cytosol is maximal at hatching.

Immunologic and epidemiologic aspects of varicella infection acquired during infancy and early childhood.

The development of varicella zoster infection was studied in a population of infants under one year of age during three outbreaks of varicella in a semi-closed domiciliary institution for infants in Japan. Over a period of four years, many residents ranging in age from 27 days to 32 months were tested for cutaneous reactivity to VZV antigen, and VZV-specific antibody activity before, during, and after each outbreak of varicella. Of these, 85 subjects developed clinical varicella, with an overall attack rate of 100% for all susceptible subjects. All the infants under 2 months of age were infected following such exposure, despite the presence of pre-existing maternal antibody. The degree of cutaneous involvement appeared to be milder (less than 20 vesicles) in infants less than 2 months of age, and severe cutaneous disease (with over 300 eruptions or confluent rash) occurred more frequently in subjects 2 to 11 months of age. Pre-existing antibody did not prevent development of illness, or alter the degree of antibody or cellular immune response to subsequent infection. However, the peak cutaneous reactivity to VZV antigen after infection was found to be significantly lower in infants under 2 months of age.

Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: Relation to pulmonary hemodynamics

In 12 patients who underwent the Fontan procedure for complex cardiac anomalies, lung scanning with xenon-133 was performed to assess the intrapulmonary ventilation-perfusion distribution, and comparison was made with a control group. All data were then analyzed in relation to either pre- or postoperative pulmonary hemodynamic data. In ventilation scans, the intrapulmonary distribution in the right lung was almost normal. In perfusion scans, an abnormal increased upper to lower lobe perfusion ratio greater than the normal value found in the control group was noted in seven patients (58.3%). There was a significant correlation (p less than 0.02) between the upper to lower lobe perfusion ratio and postoperative pulmonary vascular resistance. Furthermore, this perfusion ratio correlated inversely with the preoperative (p less than 0.005) and postoperative (p less than 0.02) right pulmonary artery area index, defined as the ratio of cross-sectional area to the normal value. Of five patients with less than 90% arterial oxygen saturation, four showed an abnormal distribution of pulmonary blood flow greater than the normal perfusion ratio. No patient had evidence of a pulmonary arteriovenous fistula by the echocardiographic contrast study. These results suggest that abnormal distribution of pulmonary blood flow to the upper lung segment may develop in patients after the Fontan procedure, and that insufficient size of the pulmonary artery before operation and the consequent postoperative elevation of pulmonary vascular resistance may be responsible for this perfusion abnormality.

Effect of the Energy Source on Changes in Energy Expenditure, Respiratory Quotient, and Nitrogen Balance during Total Parenteral Nutrition in Children

Abstract: The effects of three isocaloric intravenous nutritional regimens were studied in seven infants and children, ages 2 months to 9 yr, with congenital gastrointestinal anomalies (four patients) or with prior history of malignant disease admitted in remission for bone marrow transplantation (three patients). Energy metabolism, as measured by the basal metabolic rate (BMR), and substrate utilization, as measured by the respiratory quotient (RQ), were studied to determine the effect of different levels of carbohydrate and fat on nitrogen retention in each patient. Solution A provided 8% of energy as amino acids, 87% as carbohydrate, and 5% as fat. Solution B provided 8% of energy as amino acids, 60% as carbohydrate, and 32% as fat. Solution C provided 8% of energy as amino acids, 34% as carbohydrate, and 58% as fat. Administration of solution A (high carbohydrate, low fat) was associated with moderately increased mean (±SD) BMR and RQ and with low nitrogen retention (19.1 ± 12.7%, 1.06 ± 0.14, and 98 ± 28 mg N/kg/day). Both the BMR and the RQ decreased when less carbohydrate and more lipid was given: BMR 4.3 ± 11.6% (p < 0.005), RQ 0.92 ± 0.09 (p < 0.001) for solution B; BMR 3.94 ± 10.6% (p < 0.005), RQ 0.86 ± 0.09 (p < 0.001) for solution C. Among the solutions tested, optimal nitrogen retention [163 ± 60 mg N/kg/day (p < 0.01)] was noted with solution B. Our data support the conclusion that a physiologic balance of fat and carbohydrate results in optimal nitrogen retention.

Kappa-chain gene rearrangement in an apparent T-lineage lymphoma.

We describe a 10-yr-old boy with T-lineage non-Hodgkins lymphoma. He had a mediastinal mass, swollen supraclavicular lymph nodes, and pleural effusion. A supraclavicular lymph node biopsy under light microscopy showed a malignant lymphoma of diffuse lymphoblastic type. Most of the cells taken from the malignant pleural effusion expressed T cell-associated antigens such as Leu-1 and OKT 8. To confirm these antigens as T-lineage lymphoma, we examined genomic DNA from malignant cells obtained from the pleural effusion. As was expected, T cell receptor beta-chain gene rearrangements were demonstrated. However, when the immunoglobulin gene organization was analyzed, we detected rearrangements in both the heavy- and kappa-chain genes. To our knowledge, this is the first case in which kappa-chain gene rearrangement was detected in apparent T-lineage cells. These findings provide important information relating to determination of the cellular lineage of lymphoid malignancy.

Serum calcium regulating hormones in the perinatal period.

SummaryTo clarify perinatal vitamin D metabolism, we measured 25-hydroxyvitamin D (25OHD), 24,25-dihydroxyvitamin D [24,25(OH)2D], 1,25-dihydroxyvitamin D [1,25(OH)2D], calcium (Ca), phosphorus (P), parathyroid hormone (PTH), and human calcitonin (CT) in paired maternal, cord, and infant serum. Cord serum 25OHD was significantly lower than the maternal level, and cord serum 24,25(OH)2D was also significantly below the maternal concentrations. Maternal, cord, and infant serum 1,25(OH)2D, on the other hand, was significantly higher than the normal adult level. The serum PTH was low, but the CT concentration was high in the cord. Cord serum Ca and P levels were significantly higher than maternal. The reason for the elevated circulating 1,25(OH)2D level in the perinatal period is uncertain, and we speculate that the possible factors are gonadal steroids, placental lactogen, prolactin, and CT. In addition, serum 24,25(OH)2D and 1,25(OH)2D concentrations are under some control by the fetus.

Intranasal absorption of salmon calcitonin

SummaryEight normal subjects and 4 children with osteogenesis imperfecta were administered salmon calcitonin (S-CT) intranasally, and the phamacokinetics of S-CT were studied. In the normal subjects, the plasma S-CT concentration showed a dose-dependent increase over a dosage range of 200–400 IU. Maximal plasma concentrations were reached 20–60 min after intranasal administration of S-CT. The plasma calcium concentration was significantly decreased 60 min after the administration. In the children. S-CT was also absorbed through the nasal mucosa. This suggests that nasal spraying may be an efficient method for administration of S-CT.

Plasma 1,25-dihydroxyvitamin D concentrations in cords, newborns, infants, and children

SummaryPlasma 1,25-dihydroxyvitamin D [1,25-(OH)2-D] was measured in cord serum, newborns, infants, and children. The mean for the values obtained from the six cords was significantly higher than the mean for the older children (6–15 years). The mean for the six newborns (0–1 week) was significantly higher than that for the older children. The mean for the nine infants (1 week-6 months) and the 14 younger children (6 months-6 years) was significantly higher than that for older children. The present study suggests that the perinatal period is associated with a marked increase in 1,25-(OH)2-D.